Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Cardiology, China-Japan Friendship Hospital, No.2 East Yinghua Road, Beijing, 100029, Chaoyang District, China.
Cardiovasc Drugs Ther. 2023 Aug;37(4):705-713. doi: 10.1007/s10557-022-07317-z. Epub 2022 Feb 26.
Whether there are many risk factors for recurrence of atrial fibrillation (AF) after ablation is unclear. The aim of this study was to investigate the relationship between insulin resistance (IR) and AF recurrence in patients without diabetes who underwent catheter ablation.
This retrospective study included patients who underwent AF ablation between 2018 and 2019 at the First Affiliated Hospital of Zhengzhou University. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated, and a value of ≥2.69 was defined as IR. The patients were divided into two groups (group 1 HOMA-IR < 2.69, n = 163; group 2 HOMA-IR ≥ 2.69, n = 69). AF recurrence was defined as the occurrence of atrial arrhythmias of more than 30 s after the first 3 months. Univariate and multivariable Cox regression models were used to analyse the risk of AF recurrence.
Overall, 232 patients were enrolled (mean age, 59.9 ± 10.2 years old; female, 37.5%; paroxysmal AF, 71.6%). We found that dyslipidaemia, antiarrhythmic drug use, fasting blood glucose and fasting insulin were significantly higher in the IR group (P < 0.05). During the follow-up 1 year after ablation, 62 (26.7%) patients experienced AF recurrence. After adjusting for traditional risk factors, multivariable analysis showed that the HOMA-IR value (HR 1.259, 95% CI 1.086-1.460, P = 0.002) and left atrial diameter (LAD; HR 1.043, 95% CI 1.005-1.083, P = 0.026) were independently associated with AF recurrence.
The present results provide evidence that IR patients are more likely to experience AF recurrence. Improving IR status may be a potential target for reducing the postoperative recurrence rate.
尚不清楚消融术后心房颤动（AF）复发的危险因素是否很多。本研究旨在探讨接受导管消融治疗且无糖尿病的患者中胰岛素抵抗（IR）与 AF 复发之间的关系。
本回顾性研究纳入了 2018 年至 2019 年期间在郑州大学第一附属医院接受 AF 消融的患者。计算了胰岛素抵抗的稳态模型评估（HOMA-IR），并将≥2.69 定义为 IR。将患者分为两组（组 1 HOMA-IR<2.69，n=163；组 2 HOMA-IR≥2.69，n=69）。AF 复发定义为首次 3 个月后发生超过 30 s 的房性心律失常。采用单变量和多变量 Cox 回归模型分析 AF 复发的风险。
共纳入 232 例患者（平均年龄 59.9±10.2 岁；女性占 37.5%；阵发性 AF 占 71.6%）。我们发现，IR 组患者血脂异常、抗心律失常药物使用、空腹血糖和空腹胰岛素明显升高（P<0.05）。消融后 1 年随访期间，62 例（26.7%）患者发生 AF 复发。在调整传统危险因素后，多变量分析显示 HOMA-IR 值（HR 1.259，95%CI 1.086-1.460，P=0.002）和左心房直径（LAD；HR 1.043，95%CI 1.005-1.083，P=0.026）与 AF 复发独立相关。
本研究结果提供了证据表明，IR 患者更有可能发生 AF 复发。改善 IR 状态可能是降低术后复发率的潜在目标。
